Management of Scorpion Bites: 4-Step Approach
For scorpion stings, immediately irrigate the wound with copious water, apply ice with a barrier for pain relief, give oral acetaminophen or NSAIDs, and call emergency services if any systemic symptoms develop.
Step 1: Immediate Wound Care and Safety Measures
- Thoroughly irrigate the sting site with large volumes of clean water to reduce venom load and remove any debris 1
- Remove rings, watches, and any constricting objects from the affected extremity before swelling develops 2
- Do NOT apply suction to the sting site – this is ineffective and potentially harmful 1
- Do NOT apply tourniquets or pressure immobilization bandages as these may worsen tissue injury 2
- Do NOT cut the wound or attempt to extract venom 3
Step 2: Pain Management
- Apply ice to the sting site for local pain relief, but place a thin barrier (such as a towel) between the ice and skin to prevent tissue damage 1
- Administer over-the-counter acetaminophen or NSAIDs (ibuprofen, naproxen) for pain control 1
- If skin is intact, apply topical lidocaine 5% which has demonstrated significant pain reduction 1
- Continue pain medications as needed for several days, as most patients recover within 24-48 hours 1
Step 3: Monitor for Systemic Symptoms
- Call emergency services immediately if the patient develops any of the following systemic symptoms 1:
- Difficulty breathing or respiratory distress
- Muscle rigidity or spasms
- Dizziness or confusion
- Cardiac symptoms or arrhythmias
- Seek medical attention if pain extends beyond the sting site, becomes severe, or is not controlled by over-the-counter medications 1
- Children are at higher risk for severe envenomation and should be monitored more closely, as severe cases may require intensive care with cardiac monitoring and antivenom administration 4
Step 4: Follow-Up and Infection Monitoring
- Monitor the sting site for signs of secondary infection requiring medical attention 1:
- Progressive erythema extending beyond the initial sting site
- Purulent discharge
- Systemic signs such as fever or elevated white blood cell count
- Do NOT assume antibiotics are needed for swelling – swelling is typically caused by venom-mediated inflammatory response, not infection 1
- Antibiotics are NOT recommended prophylactically and should only be used if clear signs of infection develop 1
Important Clinical Pearls
Most scorpion stings in North America cause only local symptoms and resolve completely within 24-48 hours 1. However, bark scorpion (Centruroides) stings can cause severe systemic toxicity 1. The time to medical care is critical – patients with severe toxicity who present later have worse outcomes 4. When in doubt about symptom severity, especially in children, seek immediate medical evaluation rather than waiting.